Rural Development Direct Home Repair Program Application

United States Department of Agriculture

504

Rural Development Direct Home Repair Program Application

PLEASE SUBMIT THIS APPLICATION PACKAGE TO: USDA, Rural Development

10 Ferry Street, Suite 218, Concord, NH 03301 Phone (603) 223-6035

Email: HousingVT.NH@ USDA, Rural Development

87 State Street, PO Box 249, Montpelier, VT 05601 Phone (802) 828-6005

Email: HousingVT.NH@:

USDA is an equal opportunity provider, employer and lender. To file a complaint of discrimination, write USDA, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, S. W. Washington, D.C. 20250-9410 or Call (866) 632-9992 (Toll-free Customer Service.) Persons with disabilities who require alternative means of Communication should contact the USDA's TARGET Center at (202) 720-2600 or the USDA through the Federal Relay Services at (800) 877-8339.

JULY 17, 2020

HB-1-3550

CHECKLIST OF ITEMS TO ACCOMPANY

Attachment 12-E Page 1 of 2

APPLICATION FOR HOME REPAIR LOAN OR GRANT FUNDS

Applicant Name:

Phone:

Cell:

Co-Applicant Name:

Phone:

Cell:

Applicant Email:

Co-Applicant Email:

Preferred contact? Mail:

Phone:

Cell:

Email:

Check the boxes below when completed

REQUIRED FORMS: Please submit the following documentation:

Form 410-4, "Uniform Residential Loan Application" complete, sign and date pages 5 and 8. Form 3550-1 "Authorization to Release Information" for each adult household member. Form 3550-4, "Employment & Asset Certification" for each adult household member.

INCOME:

Verification of all household income. To qualify for the program, a household's adjusted income must be within the established income limit based on size and location. Below are some examples of income that may be applicable to all household members and what should be provided to the Agency.

o Copies of the last four week's consecutive pay stubs. o Copies of recent benefit statements for regular unearned income (such as social

Security, public assistance, retirement income, etc.). o The last 12 months payment history, of alimony and/or child support received as

provided by the court appointed entity responsible for handling payments. If this is not available, a copy of the separation agreement or divorce decree.

For each applicant, a complete copy of their last TWO signed and filed Federal Income Tax Returns. IRS Form W-2, "Wage and Tax Statement," and/or IRS Form 1099-MISC, "Miscellaneous Income", must be attached. For returns mailed to the IRS, provide a copy of the signed document. For returns filed electronically, include a copy of the Signature Page with the Self-Select PIN, confirmation that the return was accepted, or evidence that it was filed by an authorized E-File provider.

For each non-retired applicant, a written explanation of employment history of less than TWO years or employment gaps in excess of 30 days within the last TWO years.

ASSETS, CREDIT, OTHER DOCUMENTATION:

For each applicant, a copy of their TWO most recent asset/bank statements. (Note that if you are obtaining this information through online banking, you should print your bank statement, as opposed to printing the online transaction history.)

(01-23-03) SPECIAL PN Revised (10-05-17) PN 504

HB-1-3550 Attachment 12-E Page 2 of 2

For each applicant, a written explanation for late payments, collections, judgments, or other derogatory items in their credit history of which they may be aware. If applicants are unsure what their credit history looks like, they can obtain a free credit report by calling 1-877-3228228 or logging into . By law, individuals are entitled to receive one free credit file disclosure every 12 months from each of the nationwide consumer credit reporting companies ? Equifax, Experian and TransUnion. This free report cannot replace the credit report that the Agency will obtain to determine eligibility.

For each applicant, you must provide a copy of your Government Issued Photo (Picture) identification (ID) along with evidence of age or a Valid Photo Passport. Standard Verifications are a Photo Driver's License or a Passport. You must provide Photo ID for both the Applicant and Co-Applicant (if Applicable).

PLEASE NOTE: Also, we will need TWO alternative forms of ID, such as, a copy of your Pay Statement, Bank Statement, U.S. Armed Forces, Birth Certificate with Seal, Social Security Card, Credit Card, Student/Employer ID Card, Union ID Card, Professional License (Plumber, Electrician, Doctor) State ID Card, Department Store or Gas Card. Contact us if you do not have these standard verifications to discuss possible alternatives.

For a household member who is a full-time student and 18 years of age or older, a copy of their school transcript.

If applicable, provide written evidence of child-care expenses for dependents 12 years of age or younger.

If applicable, evidence of out of pocket annual medical expenses (for applicants 62 years of age and older, or individuals with a disability) who wish to be considered for a deduction to household income.

PROPERTY INFORMATION:

Evidence of Ownership: Copy of Deed, or other documentation.

Tax Statement: Most recent property tax assessment and annual statement, if applicable.

Insurance: Evidence of homeowner's hazard or flood coverage, if applicable.

Repair Bid(s) including an itemized description of repairs, material, labor, and a copy of Contractor's license, if applicable.

Mortgage Statement: Most recent copy of mortgage statement, if applicable. MISCELLANEOUS: 1. MOTHERS MAIDEN NAME FOR ALL APPLICANTS.

2. PRIOR EMPLOYER AND OCCUPATION, IF RETIRED.

3. HOW WILL THESE FUNDS BE USED?

4. THE APPROXIMATE COSTS: TWO ESTIMATES IF POSSIBLE, ATTACHED?

HB-1-3550 Attachment 12-E Page 2 of 2

Form RD 410-4 (Rev. 10-06)

Position 3

APPLICATION FOR RURAL ASSISTANCE (NONFARM TRACT)

Uniform Residential Loan Application

Form Approved OMB No. 0575-0172

This application is designed to be completed by the applicant with the lender's assistance. Applicants should complete this form as ''Applicant #1 '' or ''Applicant #2", as

applicable. All Applicants must provide information (and the appropriate box checked) when

the income or assets of a person other than the ''Applicant '' (including the

Applicant's spouse) will be used as a basis for loan qualification or

the income or assets of the Applicant's spouse will not be used as a basis for loan qualification, but his or

her liabilities must be considered because the Applicant resides in a community property state, the security property is located in a community property state, or the Applicant

is relying on other property located in a community property state as a basis for repayment of the loan.

Mortgage Applied for:

Amount

$

V.A. FHA

Conventional

I. TYPE OF MORTGAGE AND TERMS OF LOAN

Other:

Agency Case Number

Lender Account Number

USDA/Rural Housing Service

Interest Rate

No. of Months

%

Amortization Type:

Fixed Rate GPM

Other (Explain): ARM (Type):

II. PROPERTY INFORMATION AND PURPOSE OF LOAN Subject Property Address (Street, City, State, ZIP)

No. of Units

Legal Description of Subject Property (Attach description if necessary)

Year Built

Purpose of Loan

Purchase

Construction

Other (Explain):

Refinance

Construction-Permanent

Complete this line if construction or construction-permanent loan.

Year Lot Original Cost

Amount Existing Liens

Acquired

$

$

(a) Present Value of Lot $

Property will be: Primary Residence

Secondary Residence

(b) Cost of Improvements $

Total (a + b) $

Investment

0.00

Complete this line if this is a refinance loan.

Year Acquired

Original Cost

$

Amount Existing Liens $

Purpose of Refinance

Describe Improvements Cost: $

Made

To be made

Title will be held in what Name(s)

Manner in which Title will be held

Estate will be held in:

Source of Down Payment, Settlement Charges and/or Subordinate Financing (Explain)

Fee Simple

Leasehold (Show expiration date)

Applicant #1 Name (include Jr. or Sr. if applicable)

Social Security Number Home Phone (Incl. Area Code) DOB

mm/dd/yy

Ill. APPLICANT INFORMATION Applicant #2

Name (Include Jr. or Sr. if applicable)

Yrs. School Social Security Number Home Phone (Incl. Area Code) DOB

mm/dd/yy

Yrs. School

Married Separated

Unmarried (Include single Dependents (Not listed by Applicant #2)

divorced, widowed)

No. Ages

Married Separated

Unmarried (Include single Dependents (Not listed by Applicant #1)

divorced, widowed)

No Ages

.

Present Address (Street, City State, ZIP)

Own

Rent

No. Yrs. Present Address (Street, City, State, ZIP)

Own

Rent

No. Yrs.

Mailing Address if different from Present Address

Mailing Address if different from Present Address

If residing at present address for less than two years, complete the following:

Former Address (Street, City State, ZIP)

Own

Rent

No. Yrs. Former Address (Street, City, State, ZIP)

Own

Rent

No. Yrs.

Freddie Mac Form 65

Page 1 of 10

Fannie Mae Form 1003

According to the Paperwork Reduction Act 1995, an agency may not conduct or sponsor, and a person is not are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0575-0172. The time required to complete this information collection is estimated to average 1-1/2 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

Name & Address of Employer

IV. EMPLOYMENT INFORMATION Applicant #1

Self-Employed Yrs./Mos. on the job Name & Address of Employer

Yrs/Mos. employed in this line of work/profession

Applicant #2 Self-Employed Yrs./Mos. on the job

Yrs/Mos. employed in this line of work/profession

Position/Title/Type of Business

Business Phone (Incl. Area Code) Position/Title/Type of Business

If employed in current position for less than two years or if currently employed in more than one position, complete the following:

Name & Address of Employer

Self-Employed Dates (From > To) Name & Address of Employer

Position/Title/Type of Business Name & Address of Employer

Monthly Income $ Business Phone (Incl. Area Code) Position/Title/Type of Business

Self-Employed Dates (From > To) Name & Address of Employer

Position/Title/Type of Business

Monthly Income

$ Business Phone (Incl. Area Code) Position/Title/Type of Business

Business Phone (Inct. Area Code)

Self-Employed Dates (From >To)

Monthly Income $ Business Phone (Incl. Area Code) Self-Employed Dates (From > To)

Monthly Income $ Business Phone (Incl. Area Code)

Gross Monthly Income

Base Empl. Income*

$

V. MONTHLY INCOME AND COMBINED HOUSING EXPENSE INFORMATION

Applicant #1

Applicant #2

Total

Combined Monthly Housing Expense

Present

$

$

0.00 Rent

$

Overtime

0.00 First Mortgage (P&I)

$

Bonuses

0.00 Other Financing (P&I)

Commissions

0.00 Hazard Insurance

Dividends/Interest

0.00 Real Estate Taxes

Net Rental Income

0.00 Mortgage Insurance

Other (Before completing see the notice in "describe other income," below

0.00 Homeowner Assn. Dues 0.00 Other

Total

$

0.00 $

0.00 $

0.00 Total

$

0.00 $

*Self Employed Applicant may be required to provide additional documentation such as tax returns and financial statements.

Proposed

0.00

Describe Other Income Notice: Alimony, child Support, or separate maintenance income need not be revealed if the

A1/A2

Applicant #1, (A 1) or Applicant #2 (A2) does not choose to have it considered for repaying this loan.

Monthly Amount

Freddie Mac Form 65

Page 2 of 10

Fannie Mae Form 1003

VI. ASSETS AND LIABILITIES

This Statement and any applicable supporting schedules may be completed jointly by both married and unmarried Applicants if their assets and liabilities are sufficiently joined so that the Statement can be

meaningfully and fairly presented on a combined basis; otherwise separate Statements and Schedules are required. If the Applicant #2 section was completed about a spouse, this Statement and

supporting schedules must be completed about that spouse also.

Completed

Jointly

Not Jointly

Description

ASSETS

Cash deposit toward purchase held by:

Cash or Market Value

$

List checking and saving accounts below Name and Address of Bank, S&L, or Credit Union

Liabilities and Pledged Assets. List the creditor's name, address and account number for all outstanding debts,

including automobile loans, revolving charge accounts, real estate loans, alimony, child support, stock pledges, etc. Use

continuation sheet, if necessary. Indicate by (*) those liabilities which will be satisfied upon sale of real estate owned or

upon refinancing of the subject property. LIABILITIES

Monthly Payment & Months Left to Pay

Unpaid Balance

Name and Address of Company

$ Payment/Months

$

Acct. No.

$

Name and Address of Bank, S&L, or Credit Union

Acct. No.

$

Name and Address of Bank, S&L, or Credit Union

Acct. No.

$

Name and Address of Bank, S&L, or Credit Union

Acct. No.

$

Stocks & Bonds (Company name/number & $ description)

$

$

$

Life insurance net cash value

$

Face amount: $

Subtotal Liquid Assets

$

Real estate owned (Enter market value

$

from schedule of real estate owned)

Vested interest in retirement fund

$

Net worth of business(es) owned

$

(Attach financial statement)

Automobiles owned (Make and year)

$

$

$

$

Other Assets (Itemize)

$

$

$ $

Total Assets a. $

Acct. No. Name and Address of Company

Acct. No. Name and Address of Company

Acct. No. Name and Address of Company

$ Payment/Months

$

$ Payment/Months

$

$ Payment/Months

$

Acct. No. Name and Address of Company

Acct. No. Name and Address of Company

Acct. No. Name and Address of Company

$ Payment/Months

$

$ Payment/Months

$

$ Payment/Months

$

Acct. No.

Alimony/Child Support/Separate Maintenance

$

Payments Owed to:

Job Related Expense (Child care, union dues, etc.)

$

Total Monthly Payments Net Worth (a minus b) $

$ Total Liabilities b. $

Freddie Mac Form 65

Page 3 of 10

Fannie Mae Form 1003

VI. ASSETS AND LIABILITIES (cont.)

Schedule of Real Estate Owned (If additional properties are owned, use continuation sheet.)

Properly Address (Enter S if sold, PS if pending sale or R if rental being held for income)

Type of Property

Present Market Value

Amount of Mortgage & Liens

Gross Rental Income

Mortgage Payments

Insurance Maintenance Taxes & Misc.

Net Rental Income

$

$

$

$

$

$

Totals

$

0$

0$

0$

0$

0$

0

List any additional names under which credit has previously been received and indicate appropriate creditor name(s) and account number(s):

Alternative Name

Creditor Name

Account Number

VII. DETAILS OF TRANSACTION

a. Purchase price

$

b. Alterations, improvements, repairs c. Land (If acquired separately)

d. Refinance (incl. debts to be paid off)

e. Estimated prepaid items

f. Estimated closing costs

g, PMI, MIP, Funding Fee h. Discount (If Borrower will pay)

i. Total Costs (Add items a through h)

j. Subordinate financing

k. Borrower's closing costs paid by Seller I. Other Credits (Explain)

m. Loan amount (Exclude PMI, MIP Funding Fee financed)

n. PMI, MIP, Funding Fee financed o. Loan amount (Add m & n)

p. Cash from/to Borrower (Subtract j, k, l, & o from i)

VIII. DECLARATIONS If you answer ''Yes'' to any questions a through i, please use continuation sheet for explanation.

a. Are there any outstanding judgments against you? b. Have you been declared bankrupt within the past 7 years? c. Have you had property foreclosed upon or given title or deed in

lieu thereof in the last 7 years? d. Are you a party to a lawsuit?

Applicant #1 Applicant #2 Yes No Yes No

$0.00

e Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment? (This would include such loans as home mortgage loans. SBA loans, home improvement loans, educational loans, manufactured (mobile) home loans, any mortgage, financial obligation, bond, or loan guarantee. If ''Yes, " provide details, including date, name, and address of Lender, FHA or V.A. case number, if any, and reasons for the action.)

f. Are you presently delinquent or in default on any Federal debt or any other loan mortgage, financial obligation, bond, or loan guarantee? If ''Yes,'' give details as described in question e. above.

g. Are you obligated to pay alimony, child support, or separate maintenance?

h. Is any part of the down payment borrowed?

i. Are you a co-maker or endorser on a note?

j. Are you a U.S. citizen?

k Are you a permanent resident alien? l. Do you intend to occupy the property as your primary residence?

If ''Yes," complete question m. below.

m. Have you had ownership interest in a property in the last 3 years?

$0.00

(1 ) What type of property did you own-principal residence (PR), second home (SH), or investment property (IP)?

(2) How did you hold title to the home-solely by yourself (S), jointly with your spouse (SP), or jointly with another person (0)?

Freddie Mac Form 65

Page 4 of 10

Fannie Mae Form 1003

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